Pre-frailty is a geriatric syndrome that identifies a subset at high risk of progressing to frailty. (3,4,6) Frailty is multifaceted and complex and involves: gait speed, sarcopenia, endurance, balance, cognition, and malnutrition.(2,3)
Objectives:
1. The reader will learn what is the definition pre-frailty
2. The reader will learn the health implications and importance of pre-frailty
3. The reader will learn who is most at risk for being pre-frail
4. The reader will learn how to test and treat pre-frailty
Defining Pre-frailty
Pre-frailty is having 1 or 2 of the 5 following Women’s Health and Aging Studies (WHAS) and Cardiovascular Health Study (CHS) factors: unintentional weight loss greater than 10 lbs in the past year, loss in grip strength, reduction in gait speed, self reported exhaustion or fatigue, and/or a decease in physical activity.(1,3,4)
Why is understanding pre-frailty important?
Frailty was independently predictive of incident falls, worsening mobility, ADL disability, hospitalization, and death. (2,4) Currently, being pre-frail shows an intermediate risk of these outcomes as well as increased risk of becoming frail in the next 3 to 4 years.(4) Impaired physical function due to pre-frailty leads to increased functional dependence and disability in the older adult.(2) Increasing disability is associated with increased hospitalization, nursing home placement, falls, and other adverse outcomes. (2) After each hospitalization there is a decreasing level of physiologic capacity associated with difficult recovery to pre-morbid functional abilities.(2) Hospitalizations and skilled nursing care are costly and leads to higher healthcare costs. (2) Having healthy older adults that are not pre-frail will help to lower healthcare costs, improve quality of life, and lead to longer life.
Who is at risk for pre-frailty.
The key risk factors are females over the age of 80. (3,4) Being African American and living in more southern climates can increase risk. (3,4) Other factors that increase the risk of pre-frailty are: lower education, lower income, poorer health, higher rates of co-morbities, chronic diseases and disability. (2,4) Community dwelling older individuals can be at risk, but older hospitalized patients are at a greater risk. (2,4)
My suggestion for treatment is an individualized home-based exercise program consisting of exercises that target strength, flexibility, balance, gait, and cardiovascular fitness. (5) Matsuda et al. showed that a supervised 6-week, multidimensional home-based exercise program can improve physical outcomes in frail older adults. (5) Using test and retest for the measures above will help track changes in outcomes and frailty status.
Reference:
1.Lenardt MH, Kolb Cameiro NH, Betiolli SE, Melo Neu Riberio, DK, Wachholz PA, Prevalence of pre-frailty for the component of gait speed in older adults. Rev. Latino-Am. Enfermagem. 2013. May-June;21(3):734-741.
2.Lewis CB, Bottomley JM. Geriatric Rehabilitation: A clinical approach. 3rd edition. 2008. Pearson Education, Inc. Upper Saddle Ridge, NJ. Pg 157-158.
3. Xue QL. The frailty syndrome: definition and natural history. Clin. Geriatr Med. 2011. Feb; 27(10):1-15.
4. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Fraility in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001. Mar;56(3):M146-156.
5. Matsuda PN, Shumway-Cook A, Ciol MA. The effects of a home-based exercise program on physical function in frail older adults. J Geriatr Phys Ther. 2010 Apr-Jun;33(2):78-84.
6. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007 May;55(5):780-791.
7. Gobbens RJ, Van Assen MA, Luijkx KG, Wijnin-Sponselee MT, Schols JM. The Tilbury Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010.Jun;11(5):344-355.
8. Tennant KF. Assessment of fatigue in older adults: The FACIT Fatigue Scale (version 4). Try this:Issue # 30. 2012.
9. Fritz S. Lusardi M. (2010). White Paper: Walking Speed: the Sixth Vital Sign. Journal of Geriatric Physical Therapy 32(2): 2-5.
10. Reuben DB. Siu AL. An objective measure of physical function of elderly outpatients. The physical performance test. J Am Geriatr Soc. 1990. Oct;38(10):1105-1112.
Pre-frailty is a geriatric syndrome that identifies a subset at high risk of progressing to frailty. (3,4,6) Frailty is multifaceted and complex and involves: gait speed, sarcopenia, endurance, balance, cognition, and malnutrition.(2,3)
Objectives:
1. The reader will learn what is the definition pre-frailty
2. The reader will learn the health implications and importance of pre-frailty
3. The reader will learn who is most at risk for being pre-frail
4. The reader will learn how to test and treat pre-frailty
Defining Pre-frailty
Pre-frailty is having 1 or 2 of the 5 following Women’s Health and Aging Studies (WHAS) and Cardiovascular Health Study (CHS) factors: unintentional weight loss greater than 10 lbs in the past year, loss in grip strength, reduction in gait speed, self reported exhaustion or fatigue, and/or a decease in physical activity.(1,3,4)
Why is understanding pre-frailty important?
Frailty was independently predictive of incident falls, worsening mobility, ADL disability, hospitalization, and death. (2,4) Currently, being pre-frail shows an intermediate risk of these outcomes as well as increased risk of becoming frail in the next 3 to 4 years.(4) Impaired physical function due to pre-frailty leads to increased functional dependence and disability in the older adult.(2) Increasing disability is associated with increased hospitalization, nursing home placement, falls, and other adverse outcomes. (2) After each hospitalization there is a decreasing level of physiologic capacity associated with difficult recovery to pre-morbid functional abilities.(2) Hospitalizations and skilled nursing care are costly and leads to higher healthcare costs. (2) Having healthy older adults that are not pre-frail will help to lower healthcare costs, improve quality of life, and lead to longer life.
Who is at risk for pre-frailty.
The key risk factors are females over the age of 80. (3,4) Being African American and living in more southern climates can increase risk. (3,4) Other factors that increase the risk of pre-frailty are: lower education, lower income, poorer health, higher rates of co-morbities, chronic diseases and disability. (2,4) Community dwelling older individuals can be at risk, but older hospitalized patients are at a greater risk. (2,4)
How can you test and treat pre-frailty.
Tilburg Frailty Indicator
This 15 single component self-report questionnaire was found to have good reliability and validity in predicting frailty. (7)
https://www.tilburguniversity.edu/upload/ac3c1079-6188-4bea-b4af-8f552c07a1d2_tfieng.pdf
Gait Speed
Gait Speed (self selected) (9)
Test Protocol: Measure and mark a standard distance, e.g. 5 meters (16.4 feet).
Then measure and mark 5 feet before the start, and 5 feet after the middle 5 meter section.
|| 5 feetInstructions: “Walk at a comfortable pace”. Have the person perform 3 repetitions and calculate the average time.
Gait Speed = distance / time e.g. 5 meters / sec.
Quick estimates: 10 sec = 0.5 m/s, 7 sec = 0.7 m/s, 5 sec = 1.0 m/s, 4 sec = 1.25 m/s, 3 sec = 1.7 m/s
TUG
Balance and risk for falls.
http://www.ocagingservicescollaborative.org/wp-content/uploads/2014/07/Timed-Up-and-Go-TUG.pdf
FACIT-F
Fatigue is a symptom of frailty and there is no gold standard for the measurement of fatigue. (8) FACIT-F is a reliable and validated tool to measure fatigue. (8)
http://consultgerirn.org/uploads/File/trythis/try_this_30.pdf
Physical Performance Test (PPT)__
Assesses multiple domains of ADLs in the elderly. (10)
http://www.brightonrehab.com/wp-content/uploads/2012/02/Physical-Performance-Test-PPT.pdf
My suggestion for treatment is an individualized home-based exercise program consisting of exercises that target strength, flexibility, balance, gait, and cardiovascular fitness. (5) Matsuda et al. showed that a supervised 6-week, multidimensional home-based exercise program can improve physical outcomes in frail older adults. (5) Using test and retest for the measures above will help track changes in outcomes and frailty status.
Reference:
1.Lenardt MH, Kolb Cameiro NH, Betiolli SE, Melo Neu Riberio, DK, Wachholz PA, Prevalence of pre-frailty for the component of gait speed in older adults. Rev. Latino-Am. Enfermagem. 2013. May-June;21(3):734-741.
2.Lewis CB, Bottomley JM. Geriatric Rehabilitation: A clinical approach. 3rd edition. 2008. Pearson Education, Inc. Upper Saddle Ridge, NJ. Pg 157-158.
3. Xue QL. The frailty syndrome: definition and natural history. Clin. Geriatr Med. 2011. Feb; 27(10):1-15.
4. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Fraility in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001. Mar;56(3):M146-156.
5. Matsuda PN, Shumway-Cook A, Ciol MA. The effects of a home-based exercise program on physical function in frail older adults. J Geriatr Phys Ther. 2010 Apr-Jun;33(2):78-84.
6. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007 May;55(5):780-791.
7. Gobbens RJ, Van Assen MA, Luijkx KG, Wijnin-Sponselee MT, Schols JM. The Tilbury Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010.Jun;11(5):344-355.
8. Tennant KF. Assessment of fatigue in older adults: The FACIT Fatigue Scale (version 4). Try this:Issue # 30. 2012.
9. Fritz S. Lusardi M. (2010). White Paper: Walking Speed: the Sixth Vital Sign. Journal of Geriatric Physical Therapy 32(2): 2-5.
10. Reuben DB. Siu AL. An objective measure of physical function of elderly outpatients. The physical performance test. J Am Geriatr Soc. 1990. Oct;38(10):1105-1112.